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AB56-ASA1,660 12Section 660 . 49.45 (5) (a) of the statutes is amended to read:
AB56-ASA1,349,1813 49.45 (5) (a) Any person whose application for medical assistance is denied or
14is not acted upon promptly or who believes that the payments made in the person's
15behalf have not been properly determined or that his or her eligibility has not been
16properly determined may file an appeal with the department pursuant to par. (b).
17Review is unavailable if the decision or failure to act arose more than 45 days before
18submission of the petition for a hearing, except as provided in par. (ag) or (ar).
AB56-ASA1,661 19Section 661 . 49.45 (5) (ag) of the statutes is created to read:
AB56-ASA1,349,2520 49.45 (5) (ag) A person shall request a hearing within 90 days of the date of
21receipt of a notice from a care management organization or managed care
22organization upholding its adverse benefit determination relating to any of the
23following or within 90 days of the date the care management organization or
24managed care organization failed to act on the contested matter within the time
25specified by the department:
AB56-ASA1,350,3
11. Denial or limited authorization of a requested services, including a
2determination based on the type or level of service, requirement for medical
3necessity, appropriateness, setting, or effectiveness of a covered benefit.
AB56-ASA1,350,64 2. Reduction, suspension, or termination of a previously authorized service,
5unless the service was only authorized for a limited amount or duration and that
6amount or duration has been completed.
AB56-ASA1,350,77 3. Denial, in whole or in part, of payment for a service.
AB56-ASA1,350,88 4. Failure to provide services in a timely manner.
AB56-ASA1,350,119 5. Failure of a care management organization or managed care organization
10to act within the time frames provided in 42 CFR 438.408 (b) (1) and (2) regarding
11the standard resolution of grievances and appeals.
AB56-ASA1,350,1412 6. Denial of an enrollee's request to dispute financial liability, including
13copayments, premiums, deductibles, coinsurance, other cost sharing, and other
14member financial liabilities.
AB56-ASA1,350,1715 7. Denial of an enrollee, who is a resident of a rural area with only one care
16management organization or managed care organization, to obtain services outside
17the organization's network of contracted providers.
AB56-ASA1,662 18Section 662 . 49.45 (5) (ar) of the statutes is created to read:
AB56-ASA1,350,2019 49.45 (5) (ar) If a federal regulation specifies a different time limit to request
20a hearing than par. (a) or (ag), the time limit in the federal regulation shall apply.
AB56-ASA1,663 21Section 663 . 49.45 (5) (b) 1. (intro.) of the statutes is amended to read:
AB56-ASA1,351,1022 49.45 (5) (b) 1. (intro.) Upon receipt of a timely petition under par. (a) the
23department shall give the applicant or recipient reasonable notice and opportunity
24for a fair hearing. The department may make such additional investigation as it
25considers necessary. Notice of the hearing shall be given to the applicant or recipient

1and, if a county department under s. 46.215, 46.22, or 46.23 is responsible for making
2the medical assistance determination, to the county clerk of the county. The county
3may be represented at such hearing. The department shall render its decision as
4soon as possible after the hearing and shall send a certified copy of its decision to the
5applicant or recipient, to the county clerk, and to any county officer charged with
6administration of the Medical Assistance program. The decision of the department
7shall have the same effect as an order of a county officer charged with the
8administration of the Medical Assistance program. The decision shall be final, but
9may be revoked or modified as altered conditions may require. The department shall
10deny a petition for a hearing or shall refuse to grant relief if:
AB56-ASA1,664 11Section 664 . 49.45 (5) (b) 1. d. of the statutes is created to read:
AB56-ASA1,351,1512 49.45 (5) (b) 1. d. The issue is an adverse benefit determination described in
13par. (ag) 1. to 7. made by a care management organization or managed care
14organization and the person requesting the hearing has not exhausted the internal
15appeal procedure with the organization.
AB56-ASA1,664r 16Section 664r. 49.45 (6m) (ar) 1. a. of the statutes is amended to read:
AB56-ASA1,352,1117 49.45 (6m) (ar) 1. a. The department shall establish standards for payment of
18allowable direct care costs under par. (am) 1. bm., for facilities that do not primarily
19serve the developmentally disabled, that take into account direct care costs for a
20sample of all of those facilities in this state and separate standards for payment of
21allowable direct care costs, for facilities that primarily serve the developmentally
22disabled, that take into account direct care costs for a sample of all of those facilities
23in this state. The standards shall be adjusted by the department for regional labor
24cost variations. The department shall in the single labor region that is composed of
25Milwaukee, Ozaukee, Washington, and Waukesha counties include Racine County

1and shall adjust payment so that the direct care cost targets of facilities in
2Milwaukee, Ozaukee, Washington, and Waukesha counties are not reduced as a
3result of including facilities in Racine County in this labor region.
The department
4shall treat as a single labor region the counties of Dane, Dodge, Iowa, Columbia,
5Richland, Sauk, and Rock and shall adjust payment so that the direct care cost
6targets of facilities in Dane, Iowa, Columbia, and Sauk counties are not reduced as
7a result of including facilities in Dodge, Richland, and Rock Counties in this labor
8region. For facilities in Douglas, Dunn, Pierce, and St. Croix counties, the
9department shall perform the adjustment by use of the wage index that is used by
10the federal department of health and human services for hospital reimbursement
11under 42 USC 1395 to 1395ggg.
AB56-ASA1,665 12Section 665 . 49.45 (6m) (c) 5. of the statutes is amended to read:
AB56-ASA1,352,1513 49.45 (6m) (c) 5. Admit only patients assessed or who waive or are exempt from
14the requirement of assessment under s. 46.27 (6) (a) or,
if required under s. 50.035
15(4n) or 50.04 (2h), who have been referred to a resource center.
AB56-ASA1,666 16Section 666 . 49.45 (6m) (L) of the statutes is amended to read:
AB56-ASA1,352,2217 49.45 (6m) (L) For purposes of ss. 46.27 (11) (c) 7. and s. 46.277 (5) (e), the
18department shall, by July 1 annually, determine the statewide medical assistance
19daily cost of nursing home care and submit the determination to the department of
20administration for review. The department of administration shall approve the
21determination before payment may be made under s. 46.27 (11) (c) 7. or 46.277 (5)
22(e).
AB56-ASA1,677 23Section 677 . 49.45 (29w) (b) 1. b. of the statutes is amended to read:
AB56-ASA1,353,824 49.45 (29w) (b) 1. b. “Telehealth" is means a service provided from a remote
25location using a combination of interactive video, audio, and externally acquired

1images through a networking environment between an individual or a provider at
2an originating site and a provider at a remote location with the service being of
3sufficient audio and visual fidelity and clarity as to be functionally equivalent to
4face-to-face contact; or, in circumstances determined by the department, an
5asynchronous transmission of digital clinical information through a secure
6electronic communications system from one provider to another provider
.
7“Telehealth" does not include telephone conversations or Internet-based
8communications between providers or between providers and individuals.
AB56-ASA1,678 9Section 678 . 49.45 (29y) (d) of the statutes is repealed.
AB56-ASA1,680 10Section 680 . 49.45 (41) of the statutes is amended to read:
AB56-ASA1,353,1611 49.45 (41) Mental health crisis Crisis intervention services. (a) In this
12subsection, “mental health crisis intervention services" means crisis intervention
13services for the treatment of mental illness, intellectual disability, substance abuse,
14and dementia
that are provided by a mental health crisis intervention program
15operated by, or under contract with, a county, if the county is certified as a medical
16assistance provider.
AB56-ASA1,353,2517 (b) If a county elects to become certified as a provider of mental health crisis
18intervention services, the county may provide mental health crisis intervention
19services under this subsection in the county to medical assistance recipients through
20the medical assistance program. A county that elects to provide the services shall
21pay the amount of the allowable charges for the services under the medical
22assistance program that is not provided by the federal government. The department
23shall reimburse the county under this subsection only for the amount of the allowable
24charges for those services under the medical assistance program that is provided by
25the federal government.
AB56-ASA1,681
1Section 681. 49.45 (41) (c) of the statutes is created to read:
AB56-ASA1,354,42 49.45 (41) (c) Notwithstanding par. (b), if a county elects to deliver crisis
3intervention services under the Medical Assistance program on a regional basis
4according to criteria established by the department, all of the following apply:
AB56-ASA1,354,95 1. After January 1, 2020, the department shall require the county to annually
6contribute for the crisis intervention services an amount equal to 75 percent of the
7annual average of the county's expenditures for crisis intervention services under
8this subsection in calendar years 2016, 2017, and 2018, as determined by the
9department.
AB56-ASA1,354,1310 2. The department shall reimburse the provider of crisis intervention services
11in the county the amount of allowable charges for those services under the Medical
12Assistance program, including both the federal share and nonfederal share of those
13charges, that exceeds the amount of the county contribution required under subd. 1.
AB56-ASA1,354,1714 3. If a county submits a certified cost report under s. 49.45 (52) (b) to claim
15federal medical assistance funds, the claim based on certified costs made by a county
16for amounts under subd. 2. may not include any part of the nonfederal share of the
17amount under subd. 2.
AB56-ASA1,682 18Section 682 . 49.45 (47) (b) of the statutes is amended to read:
AB56-ASA1,354,2219 49.45 (47) (b) No person may receive reimbursement under s. 46.27 (11) for the
20provision of services to clients in an adult day care center unless the adult day care
21center is certified by the department under sub. (2) (a) 11. as a provider of medical
22assistance.
AB56-ASA1,683 23Section 683 . 49.45 (47) (dm) of the statutes is created to read:
AB56-ASA1,355,624 49.45 (47) (dm) Every 24 months, on a schedule determined by the department,
25an adult day care center shall submit through an online system prescribed by the

1department a report in the form and containing the information that the department
2requires, including payment of any fee due under par. (c). If a complete report is not
3timely filed, the department shall issue a warning to the operator of the adult day
4care center. The department may revoke an adult day care center's certification for
5failure to timely and completely report within 60 days after the report date
6established under the schedule determined by the department.
AB56-ASA1,686 7Section 686 . 49.46 (1) (a) 14. of the statutes is amended to read:
AB56-ASA1,355,138 49.46 (1) (a) 14. Any person who would meet the financial and other eligibility
9requirements for home or community-based services under s. 46.27 (11), 46.277, or
1046.2785 but for the fact that the person engages in substantial gainful activity under
1142 USC 1382c (a) (3), if a waiver under s. 49.45 (38) is in effect or federal law permits
12federal financial participation for medical assistance coverage of the person and if
13funding is available for the person under s. 46.27 (11), 46.277, or 46.2785.
AB56-ASA1,687 14Section 687 . 49.46 (1) (em) of the statutes is amended to read:
AB56-ASA1,355,2115 49.46 (1) (em) To the extent approved by the federal government, for the
16purposes of determining financial eligibility and any cost-sharing requirements of
17an individual under par. (a) 6m., 14., or 14m., (d) 2., or (e), the department or its
18designee shall exclude any assets accumulated in a person's independence account,
19as defined in s. 49.472 (1) (c), and any income or assets from retirement benefits
20earned or accumulated from income or employer contributions while employed and
21receiving state-funded benefits under s. 46.27 or medical assistance under s. 49.472.
AB56-ASA1,689 22Section 689 . 49.46 (2) (b) 8. of the statutes is amended to read:
AB56-ASA1,356,223 49.46 (2) (b) 8. Home or community-based services, if provided under s. 46.27
24(11),
46.275, 46.277, 46.278, 46.2785, 46.99, or under the family care benefit if a

1waiver is in effect under s. 46.281 (1d), or under the disabled children's long-term
2support program, as defined in s. 46.011 (1g).
AB56-ASA1,691 3Section 691 . 49.46 (2) (b) 15. of the statutes is amended to read:
AB56-ASA1,356,54 49.46 (2) (b) 15. Mental health crisis Crisis intervention services under s. 49.45
5(41).
AB56-ASA1,696 6Section 696 . 49.47 (4) (as) 1. of the statutes is amended to read:
AB56-ASA1,356,117 49.47 (4) (as) 1. The person would meet the financial and other eligibility
8requirements for home or community-based services under s. 46.27 (11), 46.277, or
946.2785 or under the family care benefit if a waiver is in effect under s. 46.281 (1d)
10but for the fact that the person engages in substantial gainful activity under 42 USC
111382c
(a) (3).
AB56-ASA1,697 12Section 697 . 49.47 (4) (as) 3. of the statutes is amended to read:
AB56-ASA1,356,1413 49.47 (4) (as) 3. Funding is available for the person under s. 46.27 (11), 46.277,
14or 46.2785 or under the family care benefit if a waiver is in effect under s. 46.281 (1d).
AB56-ASA1,698 15Section 698 . 49.47 (4) (b) (intro.) of the statutes is amended to read:
AB56-ASA1,356,2316 49.47 (4) (b) (intro.) Eligibility exists if the applicant's property, subject to the
17exclusion of any amounts under the Long-Term Care Partnership Program
18established under s. 49.45 (31), any amounts in an independence account, as defined
19in s. 49.472 (1) (c), or any retirement assets that accrued from employment while the
20applicant was eligible for the community options program under s. 46.27 (11), 2017
21stats.,
or any other Medical Assistance program, including deferred compensation
22or the value of retirement accounts in the Wisconsin Retirement System or under the
23federal Social Security Act, does not exceed the following:
AB56-ASA1,706 24Section 706 . 49.472 (3) (b) of the statutes is amended to read:
AB56-ASA1,357,8
149.472 (3) (b) The individual's assets do not exceed $15,000. In determining
2assets, the department may not include assets that are excluded from the resource
3calculation under 42 USC 1382b (a), assets accumulated in an independence
4account, and, to the extent approved by the federal government, assets from
5retirement benefits accumulated from income or employer contributions while
6employed and receiving medical assistance under this section or state-funded
7benefits under s. 46.27, 2017 stats. The department may exclude, in whole or in part,
8the value of a vehicle used by the individual for transportation to paid employment.
AB56-ASA1,707 9Section 707 . 49.472 (3) (f) of the statutes is amended to read:
AB56-ASA1,357,1310 49.472 (3) (f) The individual maintains premium payments under sub. (4) (am)
11and, if applicable and to the extent approved by the federal government, premium
12payments calculated by the department in accordance with sub. (4) (bm), unless the
13individual is exempted from premium payments under sub. (4) (dm) or (5).
AB56-ASA1,708 14Section 708 . 49.472 (4) (am) of the statutes is amended to read:
AB56-ASA1,357,1715 49.472 (4) (am) To the extent approved by the federal government and except
16as provided in pars. (dm) and (em) and sub. (5), an individual who receives medical
17assistance under this section shall pay a monthly premium of $25 to the department.
AB56-ASA1,709 18Section 709 . 49.472 (5) of the statutes is repealed.
AB56-ASA1,722 19Section 722 . 49.849 (1) (e) of the statutes is amended to read:
AB56-ASA1,357,2320 49.849 (1) (e) “Public assistance" means any services provided as a benefit
21under a long-term care program, as defined in s. 49.496 (1) (bk), medical assistance
22under subch. IV, long-term community support services funded under s. 46.27 (7),
23or aid under s. 49.68, 49.683, 49.685, or 49.785.
AB56-ASA1,723 24Section 723 . 49.849 (2) (a) (intro.) of the statutes is amended to read:
AB56-ASA1,358,8
149.849 (2) (a) (intro.) Subject to par. (b), the department may collect from the
2property of a decedent by affidavit under sub. (3) (b) or by lien under sub. (4) (a) an
3amount equal to the medical assistance that is recoverable under s. 49.496 (3) (a), the
4long-term community support services under s. 46.27, 2017 stats., that is
5recoverable under s. 46.27 (7g) (c) 1., 2017 stats., or the aid under s. 49.68, 49.683,
649.685, or 49.785 that is recoverable under s. 49.682 (2) (a) or (am), and that was paid
7on behalf of the decedent or the decedent's spouse, if all of the following conditions
8are satisfied:
AB56-ASA1,724 9Section 724 . 49.849 (6) (a) of the statutes is renumbered 49.849 (6).
AB56-ASA1,725 10Section 725 . 49.849 (6) (b) of the statutes is repealed.
AB56-ASA1,728 11Section 728 . 50.03 (3) (b) (intro.) of the statutes is amended to read:
AB56-ASA1,358,1612 50.03 (3) (b) (intro.) The application for a license and, except as otherwise
13provided in this subchapter,
the report of a licensee shall be in writing upon forms
14provided by the department and shall contain such information as the department
15requires, including the name, address and type and extent of interest of each of the
16following persons:
AB56-ASA1,729 17Section 729 . 50.03 (4) (c) 1. of the statutes is amended to read:
AB56-ASA1,359,218 50.03 (4) (c) 1. A community-based residential facility license is valid until it
19is revoked or suspended under this section. Every 24 months, on a schedule
20determined by the department, a community-based residential facility licensee
21shall submit through an online system prescribed by the department a biennial
22report in the form and containing the information that the department requires,
23including payment of the fees required any fee due under s. 50.037 (2) (a). If a
24complete biennial report is not timely filed, the department shall issue a warning to
25the licensee. The department may revoke a community-based residential facility

1license for failure to timely and completely report within 60 days after the report date
2established under the schedule determined by the department.
AB56-ASA1,730 3Section 730 . 50.033 (2m) of the statutes is amended to read:
AB56-ASA1,359,114 50.033 (2m) Reporting. Every 24 months, on a schedule determined by the
5department, a licensed adult family home shall submit through an online system
6prescribed by the department
a biennial report in the form and containing the
7information that the department requires, including payment of the any fee required
8due under sub. (2). If a complete biennial report is not timely filed, the department
9shall issue a warning to the licensee. The department may revoke the license for
10failure to timely and completely report within 60 days after the report date
11established under the schedule determined by the department.
AB56-ASA1,731 12Section 731 . 50.034 (1) (a) of the statutes is amended to read:
AB56-ASA1,359,2113 50.034 (1) (a) No person may operate a residential care apartment complex that
14provides living space for residents who are clients under s. 46.27 (11) or 46.277 and
15publicly funded services as a home health agency or under contract with a county
16department under s. 46.215, 46.22, 46.23, 51.42 or 51.437 that is a home health
17agency unless the residential care apartment complex is certified by the department
18under this section. The department may charge a fee, in an amount determined by
19the department, for certification under this paragraph. The amount of any fee
20charged by the department for certification of a residential care apartment complex
21need not be promulgated as a rule under ch. 227.
AB56-ASA1,732 22Section 732 . 50.034 (2m) of the statutes is created to read:
AB56-ASA1,360,923 50.034 (2m) Reporting. Every 24 months, on a schedule determined by the
24department, a residential care apartment complex shall submit through an online
25system prescribed by the department a report in the form and containing the

1information that the department requires, including payment of any fee required
2under sub. (1). If a complete report is not timely filed, the department shall issue a
3warning to the operator of the residential care apartment complex. The department
4may revoke a residential care apartment complex's certification or registration for
5failure to timely and completely report within 60 days after the report date
6established under the schedule determined by the department. Notwithstanding the
7reporting schedule under this subsection, a certified residential care apartment
8complex shall continue to pay required fees on the schedule established in rules
9promulgated by the department.
AB56-ASA1,733 10Section 733 . 50.034 (3) (a) 1. of the statutes is repealed.
AB56-ASA1,734 11Section 734 . 50.034 (5m) of the statutes is amended to read:
AB56-ASA1,360,1912 50.034 (5m) Provision of information required. Subject to sub. (5p), when
13When a residential care apartment complex first provides written material
14regarding the residential care apartment complex to a prospective resident, the
15residential care apartment complex shall also provide the prospective resident
16information specified by the department concerning the services of a resource center
17under s. 46.283, the family care benefit under s. 46.286, and the availability of a
18functional screening and a financial and cost-sharing screening to determine the
19prospective resident's eligibility for the family care benefit under s. 46.286 (1).
AB56-ASA1,735 20Section 735 . 50.034 (5n) (intro.) of the statutes is amended to read:
AB56-ASA1,361,221 50.034 (5n) Required referral. (intro.) Subject to sub. (5p), when When a
22residential care apartment complex first provides written material regarding the
23residential care apartment complex to a prospective resident who is at least 65 years
24of age or has developmental disability or a physical disability and whose disability
25or condition is expected to last at least 90 days, the residential care apartment

1complex shall refer the prospective resident to a resource center under s. 46.283,
2unless any of the following applies:
AB56-ASA1,736 3Section 736 . 50.034 (5p) of the statutes is repealed.
AB56-ASA1,737 4Section 737 . 50.034 (6) of the statutes is amended to read:
AB56-ASA1,361,105 50.034 (6) Funding. Funding for supportive, personal or nursing services that
6a person who resides in a residential care apartment complex receives, other than
7private or 3rd-party funding, may be provided only under s. 46.27 (11) (c) 7. or 46.277
8(5) (e), except if the provider of the services is a certified medical assistance provider
9under s. 49.45 or if the funding is provided as a family care benefit under ss. 46.2805
10to 46.2895.
AB56-ASA1,738 11Section 738 . 50.035 (4m) of the statutes is amended to read:
AB56-ASA1,361,1912 50.035 (4m) Provision of information required. Subject to sub. (4p), when
13When a community-based residential facility first provides written material
14regarding the community-based residential facility to a prospective resident, the
15community-based residential facility shall also provide the prospective resident
16information specified by the department concerning the services of a resource center
17under s. 46.283, the family care benefit under s. 46.286, and the availability of a
18functional screening and a financial and cost-sharing screening to determine the
19prospective resident's eligibility for the family care benefit under s. 46.286 (1).
AB56-ASA1,739 20Section 739 . 50.035 (4n) (intro.) of the statutes is amended to read:
AB56-ASA1,362,521 50.035 (4n) Required referral. (intro.) When a community-based residential
22facility first provides written information regarding the community-based
23residential facility to a prospective resident who is at least 65 years of age or has
24developmental disability or a physical disability and whose disability or condition is
25expected to last at least 90 days, the community-based residential facility shall refer

1the individual to a resource center under s. 46.283 or, if the secretary has not certified
2under s. 46.281 (3) that a resource center is available in the area of the
3community-based residential facility to serve individuals in an eligibility group to
4which the prospective resident belongs, to the county department that administers
5a program under ss. 46.27 or 46.277
, unless any of the following applies:
AB56-ASA1,740 6Section 740 . 50.035 (4p) of the statutes is repealed.
AB56-ASA1,741 7Section 741 . 50.04 (2g) (a) of the statutes is amended to read:
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